地塞米松硬膜外注射引起精神障碍2例

地塞米松硬膜外注射引起精神障碍２例天津蓟县解放军第２６９医院（３０１９００）李荫斗，朱树光我院自１９７８～１９９２年，为腰椎间盘突出症患者行硬膜外注射治疗计１３２０例，发生精神障碍２例，现报告如下。例１、柳××，男，４２岁，因腰痛伴右下肢麻木、疼痛、...     

硬膜外痛点注射强的松龙治疗腰椎间盘突出症

腰椎间盘突出症(LDH)是腰腿痛的常见病因。迄今虽无准确的发病率统计,但临床多见。患者疼痛剧烈,日常生活受限。因导致LDH的诱因及机理复杂,目前临床上仍未有满意的根治性方案。我们于近年来对162例LDH伴严重腰腿痛患者采用痛点硬膜外注射强的松龙和利多卡因混合液,经观察疗效甚佳,总结如下。资料与方法一般资料162例患者中,男104例,女58例,年龄32～78岁,L5～S1突出102例,L4～L5突出60例;左侧98例,右侧64例。入选标准:患者临床症状体征明显,且均经CT、MR确诊为LDH,腰及下肢疼痛严重,VAS8分以上,直腿抬高试验15°左右。操作方法嘱…     

硬膜外腔注射地塞米松引起精神障碍2例报道

我院创建颈肩腰腿痛专科近１０年，为颈肩腰腿痛病人行硬膜外腔注射结合手法治疗８８５例，但发生精神障碍２例，现报道如下：例１，女，５６岁，退休工人，性格内向．因腰痛伴左下肢放射痛６年加重１个月入院。入院后经ＣＴ扫描提示：腰椎４－５椎间盘突出症。既往身体健康，无任何精神障碍史，家族中无精神障碍者。患者住院前７天行静脉滴注２０％甘露醇２５０ｍｌ、１０％葡萄糖５００ｍｌ、６５４－２２０ｍｇ、维生素Ｂ６２００ｍｐ、维生素Ｃ２ｇ、复方丹参注射液１６ｍｌ，一日一次。并配合卧板床治疗一周后患者腰背肌舒展，腰痛伴左…     

硬膜外腔注射治疗腰椎间盘突出症216例体会

腰椎间盘突出症是腰腿痛的常见原因之一。其治疗难度大，疗程较长、易复发，若不及早治疗致残率高、严重影响劳动人民的身心健康。笔者自1997年至2004年元月经硬膜外腔注射类固醇激素配合一般物理疗法治疗本症，效果满意，兹报告如下：     

硬膜外腔注射后牵引治疗腰椎间盘突出症82例

自 198 8年 12月～ 1998年 12月作者采用硬膜外腔注射后牵引治疗腰椎间盘突出症 82例 ,疗效满意 ,报告如下。1　临床资料本组 82例 ,男 33例 ,女 49例。年龄37～ 5 5岁 ,平均 44 .5岁。病程 3月～ 4年 ,平均 1.2年。主要症状为腰痛伴下肢放射痛。体格检查为腰部活动障碍 ,椎体及椎旁压痛 ,直腿抬高试验阳性。患侧下肢存在感觉、肌力及腱反射改变。 X- ray示腰椎骨质增生 ,腰椎间隙狭窄。全部病例行 CT扫描 ,部分还行椎管造影、MRI检查。结果 :L3,4突出 2例 ,L4,5突出 43例 ,L5S1 突出 31例 ,L4,5及 L5S1 二处突出 6例。选择诊断明确尚…     

双侧硬膜外腔侧隐窝注射胶原酶治疗中央型腰椎间盘突出症8例

近来 ,采用双侧硬膜外腔侧隐窝注射胶原酶的方法治疗中央型腰椎间盘突出症 (L4,5,L5S1 ) 8例 ,疗效满意 ,现报告如下。1　临床资料本组 8例 ,男 3例 ,女 5例 ,平均年龄 43岁 (36～ 5 4岁 ) ,平均病程 2年 (1月～ 6年 ) ,全部经 CT扫描证实为 L4,5椎间盘中央型突出 6例 ,L5S1 突出 2例 ,并摄腰椎正侧位片 (等比例 ) ,依据病史症状体征及 X线表现相符合为确诊标准。还参考 Mcculloch[1 ] (1983)制定的诊断标准 ,即 :(1)腿痛重于腰痛 ;(2 )神经支配区的感觉减退 ;(3)直腿抬高小于正常的 5 0 % ;(4)腱反射异常 ;(5 )加强试验阳性。治疗方法…     

侧入法硬膜外腔注射曲安缩松治疗腰椎间盘突出症

1　临床资料自 1998年 8月至 2 0 0 0年 7月采用曲安缩松 4 0 m g,2 %利多卡因 10 m l,0 .9% N.S10 m l混合液用侧入法注入硬膜外腔共治疗腰椎间盘突出症 12 0例 ,其中男 6 8人 ,女 5 2人 ,年龄 2 8～ 78岁 ,平均 37.8岁 ,病史 2月～ 15年 ,平均 3年零 1月。 L4 ,5椎间盘突出 70人占5 8.3% ,L5,S1 椎间盘突出 5 0人占4 1.7% ,全部用 CT检查确诊。所有患者均表现明显神经根刺激征 ,直腿抬高试验均为 ( ) ,主要症状包括 :腰痛 ,单侧下肢或双侧下肢的注射痛及皮肤感觉减退 ,间歇性跛行。操作方法　患者取屈髋屈膝侧卧位(患肢在下 )严格消毒…     

椎旁注射治疗腰椎间盘突出症

目的探索一种治疗腰椎间盘突出症,安全、有效的治疗方法。方法选择腰椎间盘突出症病人520例,随机分为观察组(椎旁注射)、对照组(硬膜外注射),每组各260例,观察其治疗效果、操作时间、一般并发症的发生率。结果观察组分别为95.38%、23±4分、4.62%,对照组分别为88.08%、35±5分、18.85%。两组治疗效果、操作时间、一般并发症的发一率相比较,经x2检验,无前显著性差异,P<0.05。结论椎旁注射,治疗腰椎间盘突出症,操作简单,穿刺容易,治疗时间短,成功率高,并发症少,是疼痛科治疗腰椎间盘突出症比较理想的方法之一。     

盘内注射胶原酶结合硬膜外封闭治疗腰椎间盘突出症的临床观察

目的研究盘内注射胶原酶结合硬膜外封闭治疗腰椎间盘突出症的临床效果。方法自2010-05—2011-05采用盘内注射胶原酶结合硬膜外封闭治疗腰椎间盘突出症20例(观察组),并与同期单纯采用盘内注射胶原酶治疗的腰椎间盘突出症20例(对照组)进行比较。比较2组术后疼痛持续时间,以及术后3、4、5周的疼痛缓解情况。结果 40例术后均获得平均6.5(5~10)个月随访。对照组疼痛持续时间为10个月,观察组疼痛持续时间为5个月,观察组疼痛持续时间明显短于对照组,差异有统计学意义(P<0.05)。观察组术后3、4、5周疼痛缓解率均高于对照组,差异有统计学意义(P<0.05)。结论采用盘内注射胶原酶结合硬膜外封闭治疗腰椎间盘突出症可以有效缓解术后疼痛,并取得较好的治疗效果。     

硬膜外腔侧方置管法注射胶原酶治疗腰椎间盘突出症

我院采用硬膜外腔注射胶原酶治疗腰椎间盘突出症120例,其中113例在安置硬膜外腔导管时,采取穿刺针口朝向患侧方向置管,然后注药,疗效满意,现报告如下。     

Spontaneous epidural hematoma--report of two cases

We report two cases of spontaneous epidural hematoma associated with the hemorrhagic diathesis and the paranasal sinusitis. Case 1: A 31-year-old man with a history of subtotal gastrectomy because of gastric cancer. He complained of headache at left temporal region, but CT scan showed no abnormal finding. After about 12 hours, he was found in comatose state. Emergency CT scan showed left epidural hematoma. He had the thrombocytemia and hemorrhagic diathesis which were supposed to be the side effect of the chemotherapy or DIC. Although the epidural hematoma was removed at emergency, he died 5 days after the operation, because of severe brain swelling. Case 2: A 34-year-old woman with a history of paranasal sinusitis. At 3 weeks after her fourth delivery, she had a headache and a right orbital swelling. She was admitted to the otorhinolaryngologist under the diagnosis of the acute paranasal sinusitis and orbital phlegmone. After admission, the level of consciousness became worse, she was given neurosurgical consultation. Angiogram showed right temporal mass lesion. At operation, the epidural hematoma was found and evacuated. She was discharged without any neurological deficits.     

自发性椎管内硬膜外血肿2例报告

<正>自发性椎管内硬膜外血肿(spontaneous spinal epidural hematoma,SSEH)在临床较为少见,原因不明,临床易漏诊误诊,并可能导致永久性神经功能损害。2014年9月~2015年9月,我院脊柱骨科收治了2例SSEH患者,报道如下。病例1,女,76岁,因"突发双下肢瘫痪5d"于2014年9月9日入院。患者于5d前无明显诱因突发胸背部疼痛,后出现双下肢感觉及运动消失,伴大小便失禁。遂至当地医院住院治疗,MRI检查提示T7~L1椎管后部硬膜外长梭形病变,考虑血管畸形或血管瘤破裂出血伴血肿形成可能     

Air in acute epidural hematomas. Report of two cases

Two pediatric patients with acute epidural hematomas containing air bubble(s) are reported. A skull fracture was observed extending to the mastoid cells of the temporal bone in both patients. In one patient the hematoma and air bubbles subsequently increased in volume, requiring a craniotomy. The clinical significance of air in an acute epidural hematoma is discussed.     

Bilateral posterior fossa epidural hematoma--report of two cases.

Two cases of posttraumatic bilateral posterior fossa epidural hematoma are presented. Such hematomas are extremely rare, but can be surgically cured. Computed tomography helps to establish the diagnosis and determine the neurosurgical treatment.     

Spinal cord injury caused by epidural B-cell lymphoma: report of two cases

BACKGROUND/OBJECTIVE: Spinal cord injury (SCI) caused by cancer is increasing in incidence as the mean age of our patient population increases. Understanding the prognosis and functional outcome requires knowledge of diseases of the spinal column. This paper presents the unusual presentation of epidural B-cell lymphoma. METHODS: Case reports. RESULTS: Two patients presented with an unusual cause of SCI, namely B-cell lymphoma. Both patients presented with sensory deficits greater than motor deficits and gait disorder. Both achieved functional independence at the community ambulation level and tumor remission with chemotherapy and radiation therapy. CONCLUSIONS: B-cell epidural tumors are an uncommon cause of SCI. Functional outcome can be quite good, as can tumor outcome. Residual sensory deficits greater than motor deficits are not uncommon.     

Collagenase chemonucleolysis via epidural injection. A review of 252 cases

Since 1975, collagenase has been injected into 252 herniated intervertebral discs for treatment of sciatica. Highly purified preparations of Chinese collagenase were extracted from Clostridium histolyticum CH 1093 in lyophylized form, which had a specific collagenolytic activity. It had a wide margin of safety as proven by repeated experiments in dogs by means of intradiscal, extradural, intradural, and intravenous injections. One hundred to two hundred units of collagenase dissolved in 5 ml of normal saline was injected epidurally in front of the line joining posterior vertebral body margins. The basic assumption is that the injected enzyme digested the nucleus pulposis. Symptoms disappeared or improved gradually within three to eight weeks. The total success rate was about 77%. For recurrent cases of those with less than satisfactory results, reinjections were performed without any visible antigenic reactions or neurologically adverse effects.